Mri Link Gets Mixed Reactions

Seconds after patients are scanned by Allentown Osteopathic Medical Center's new MRI, images of their brains, knees and other body parts appear on computer screens some 60 miles away in Philadelphia.

There, radiologists from the University of Pennsylvania see and interpret the X-ray-like images while Osteopathic's patients are still on the table at the 19th Street Health Center.

Osteopathic officials sought a contract with Penn because the university's radiology department is considered one of the best in the country. Billboards posted by the 150-bed hospital tout the service as "World-class MRI" with "hometown access."

Such affiliations are the wave of the future, offering patients a greater level of expertise than a small community hospital or independent center could afford, according to officials from Osteopathic, Penn and one owner of a chain of independent MRI centers.

Penn employs sub-specialists in radiology who concentrate on interpreting MRIs of just the nerves, muscles or bones, heart, urinary tract and abdomens.

"For an institution in Allentown to duplicate what we have, it would have to hire five different people," said Dr. Stanley Baum, chairman of Penn's radiology department.

But other area radiologists caution against long-distance interpretation of MRI images without a radiologist on site to examine the patients and explain the images to them and their physicians.

"In the hands of qualified and expert people it can be very good," said Dr. Mark Osborne, an MRI-trained radiologist at Lehigh Valley Hospital. "The drawback is you don't have local consultation ... It's harder to get good communication."

The first discussion that should take place, according to Dr. Michael Polise, a neuroradiologist at St. Luke's Hospital in Fountain Hill, is whether MRI, which costs $800 to $1,000 per scan, is needed to diagnose the patient's problem.

Magnetic resonance imaging, or MRI, allows physicians to obtain multiple, cross-sectional images of internal organs and tissue without harmful radiation. But for some conditions, Polise said, MRI is not always better than traditional X-rays, CAT scans or other tests.

The main role of an MRI radiologist on site, said Easton Hospital's Dr. Matthew Pollack, is to explain the MRI images to patients and their referring physicians.

By example, Pollack said he recently spent two hours reviewing ankle studies with a podiatrist.

"Such rapport is obviously lacking when interpretations are made by some distant, virtually anonymous doctor, who is unknown to the clinician," he said.

Osteopathic employs two technologists who received training at Penn to run the MRI. In addition, the hospital's radiologists work in the same building or across the street at the hospital. They are available when needed, officials said, to physically examine a patient or to inject contrast material.

Dr. Asad Shohadai, chairman of radiology at Osteopathic, said he would have preferred having a hospital radiologist on site, supervising MRI service, but when the contract was signed, the staff did not have a radiologist trained in MRI.

He said he hopes to remedy that in the future, now that one of the hospital's four radiologists is fully trained in MRI. Hospital officials add that discussions are under way with a physician who would be on site in case of emergencies.

Pollack, who trained at Penn, said the expertise of major research centers should be reserved for difficult cases that need a second opinion. Even then, he said, Penn's experts should do it as a professional courtesy.

Osborne and Pollack said Penn appears to be motivated more by money than the improvement of science or patient care.

Senior Vice President Evon Midei said Osteopathic pays Penn nothing for the "teleradiology" equipment, similar to a fax machine, that uses phone lines to send images 60 miles away in seconds. Also, Midei said, Penn radiologists bill as they would to interpret MRI scans for Philadelphia patients, but accept Allentown's payment rates.

Osteopathic officials learned about the service from equipment manufacturers in spring, when officials replaced a five-year-old MRI magnet with a new, more powerful version.

Allentown attorney Peter Karoly, whose Physician Imaging Centers in Bethlehem, Wilkes-Barre and Camp Hill, Cumberland County, hire doctors to be on site but also use teleradiology, said links between universities and community medical centers improve care and save money.

He said it's important to have a physician available if a patient reacts badly to sedation medication or an injection of contrast material. Also, a radiologist should train technicians and monitor the quality of MRI images, Karoly said.

But thanks to technology, he said, radiologists do not need to be on site all hours of operation.